Dental Health – Dr. Philip Buckler DDS
/in Podcast/by dmiddaughDr. David
Hello El Paso! This is Dr. David, expert physical therapist. I'm the owner of El Paso Manual Physical Therapy. Welcome to the Stay Healthy El Paso Podcast. I've got with me here today Philip Buckler, he is an expert dentist and has, to me worded most clearly, and most succinctly explained things about dentistry, that I never understood.
Of course, I've grown up going to the dentist my whole life. But I love the way that Philip explains things, whenever asked him questions. Full disclosure, he's a patient of mine. He's really close. He's had an awesome experience here at El Paso Manual Physical Therapy, and I wanted to bring him on the podcast, because he has fantastic advice for dental health.
I wanted you guys you listeners, to be able to experience that from Philips. I've got some questions for him, but before we go into that though, Philip, please tell me a bit about yourself. Where are you from, and how did you end up in El Paso?
Philip Buckler
Okay, I'm originally from Oregon. I went to dental school in Michigan. I ended up in El Paso for my job and I fell in love with the city, and also met my wife here. I've lived in El Paso since the end of 2011 actually integrated from dental school in 2010.
Dr. David
Fantastic, awesome! And of course, you've been practicing as a dentist since then.
Philip Buckler
Yes, with a one year add residency, which is kind of an additional year of training beyond dental school.
Dr. David
Awesome. So, you're a super dentist, then…
Philip Buckler
I wouldn't go that far. But the extra training was very beneficial.
Dr. David
Awesome. And your experience, you've treated a variety of ages and specialties. Is that right?
Philip Buckler
Yes, I believe the oldest person that I've seen was 96, I want to say, and the youngest person that I've seen, I've seen a few children as young as a few months old. I'm not a pediatric dentist. Pediatric dentist tells you something that contradicts what you hear for me, go with what the pediatric dentist says with regards to children.
Dr. David
I wanted to pull out of Philip here for you guys. Just some clear up some general health tips. Get clear on a few dental ideas, dental hygiene ideas, and hopefully this is helpful for you listeners at home or wherever you are in the car, at the gym, wherever you're listening to this right now.
One of the most common questions that I hear people talk about is, how many times a day do I need to brush, is it once or twice? Is it after every meal? Should I be impulsive about this? What do you have to say about that? Phil?
Philip Buckler
Well, the answer to that is, for me, it's more comparable to any other area of hygiene. You just need to keep the surfaces clean, a tooth surface that is kept clean, will not develop decay. Unless, there are a large number of other factors present. But good hygiene will cover over a multitude of other potential drawbacks, either genetic or coming from additional treatment like cancer, that sort of thing.
Dr. David
Gotcha. If you had to make a general recommendation, and we have talking a little bit before, as you mentioned about assuming that your genetics aren't that great, so you have to just brush so often.
Philip Buckler
Assuming each surface in your mouth is cleaned at least once every 24 hours each tooth surface is cleaned once every 24 hours, you're good. The standard recommendation is two brushings a day. But if you can get them all in one brushing, or one brushing and flossing, right before bed, so everything's nice and clean before you go to bed. For many people that will be adequate.
The criteria for success will vary from person to person. Because the criteria for success is your teeth are staying in your head, you're not developing periodontal disease and you're not developing decay. If you aren't developing ant new cavities, and your teeth aren’t starting to get loose and fall out, and your dentist tells you that you're not losing bone around your teeth, then whatever level of hygiene you're practicing is adequate, or at least close enough to it for long term sustainability to have your teeth last as long as you do.
Dr. David
So basically, you have to figure out a little trial and error, work with your dentist to get feedback on is what I'm doing enough? Can I back off a bit and be okay still that that's generally how you should proceed?
Philip Buckler
Yeah, many people, if you brush and floss very thoroughly once a night before bed. That's often adequate. My wife, before I met her, she hadn't seen a dentist for seven years, but her teeth are better than mine. And they are clean. I'm jealous. I hope our kids get her teeth. So that just shows the disparity. Some people have to work at it more than others. So again, don't assume that you fall into the easiest portion of the population because that's a good way to lose your teeth. But there is a wide variability.
Dr. David
My wife's the same way. When I met my wife, I had just started flossing regularly because I had the dentist told me I needed flossing. I didn't know how to floss. I finally had a dental hygienist take literally, maybe three minutes, four minutes and showed me how to do it. She taught me about the hug and pull,
Philip Buckler
Using it as a scraper on the inside of the teeth, as it helps to see go back and forth.
Dr. David
It's been a game changer. We taught our kids, but my wife said, when she saw me regularly flossing every day, she said “Really, you floss all the time who does that?” And she put her hands in her hips and said, “I've never had a cavity and I've never floss” and I was like “well I've had a lot of cavities!”
Philip Buckler
Good for her. I'm glad she can get away with it. But most people can't. And for anyone who doesn't like to floss, then in your case, the best form of dental insurance the best gift you can give yourself and it will save you thousands of dollars is a very high-end electric toothbrush. Very high-end Sonicare or an Oral-B. Something that will produce enough agitation inside your mouth against your teeth that will help flush out there in between the teeth.
Now that's the next best thing, and I actually have had people who use those, fool me into thinking they were flossing on a routine basis, which probably doesn't impress my fellow practitioners or any hygienists but I'm sure it's happened occasionally.
They're good products and I don't get any kickback from them. I've used both of them myself. It's just individual preference. Yeah. Other products that help her Water pick super floss. I'm not particularly picky about how my patients get their teeth clean as long as they are clean and they're not developing cavities and they're not they're not losing bone so it looks like the bony support for their teeth will last them through the rest of their lives. A lot of time.
Dr. David
You know about the motorized toothbrushes, what did you call them again?
Philip Buckler
Like a Sonicare or an Oral-B? Those are the two big brands, but there are a lot of other good brands.
Dr. David
I'll never forget, growing up, and I heard you use the same words that I've heard of the dentist say, a high-end toothbrush. And automatically when the dentist said that. I remember telling my mom that I needed a high-end toothbrush and I got the sense of “Oh, we can't afford that it's too high end.” Then when I actually bought my first one, I said that was 40 bucks, relative to a normal toothbrush is maybe 10 times more, or however many times more it is, but those… I got a Sonicare and it has been one of the best investments ever made. It is completely different brushing your teeth, one of those rather than a regular toothbrush.
Philip Buckler
And as long as it prevents at least one cavity, you've more than made your money back. Or if you get one of the $200 toothbrushes, then it might take a couple of cavities prevention. But it's an investment that will repay itself. It's cheaper and more effective than dental insurance.
Dr. David
Oh, yeah. So, we started taking our kids to the dentist, because they are getting bigger, they get more teeth of course, and from the get-go, we didn't want to get them kid’s toothbrushes. Because the brush heads on the Sonicare toothbrushes that we have, are actually kind of small, smaller than the normal toothbrushes, and they fit in my kids mouths better.
Plus, they think it's entertaining to the thing buzzes in their mouth, and they loved it. So, from the get-go, we started having them get used to Sonicare toothbrush, and every time we take them to the dentist, they're like, wow, your kids teeth look great. their gums look great. Just keep doing what you're doing, is what they tell us. I've loved those toothbrushes. I can't go back anymore.
Philip Buckler
Yeah, I'm going to be making sure that each of my kids has a good electric toothbrush. One that runs off double A batteries, does not qualify as a high-end toothbrush. It's more of a gimmick toothbrush better than nothing. Now, don't get me wrong, some people can do everything with a manual toothbrush. I've seen plenty of people who do that, but if you need that extra umpf, it'll really save you time and money, and time and pain in the dental chair.
Dr. David
Oh yea, that's no fun.
Philip Buckler
But dentistry is very friendly these days, relative to how it used to be.
Let's see what else to talk about. Oh, yeah. So generally speaking, I tend to compare people's teeth to the treads on your tires, they will wear down over time thousands of cycles a day. Every day, every year all your life. Your teeth are like anything else mechanical. They are like any other part of your body. They do wear down, they will get sensitive. Some people have problems with their knees, some people don't.
It's the same with people's teeth. A lot of people ask me about jaws clicking, cracking and popping. Again, there's a lot of individual variation on that. I generally say that some people's jaws are more flexible, and others cannot. It's kind of like some people can crack their knuckles or make a habit of doing it.
Again, that's an oversimplification. There's a wide variety of things that go into that. But when your jaw opens, it actually goes through two forms of movement. The first is a purely rotational type of movement for the first half. And then the second half is when you're opening to the full extent. That is what we call a translation movement where the combine all of your mandible is actually moving against the maxilla and physically shifting out of place rather than just rotating to the socket.
To help facilitate that, your body has a disc of cartilage, like it does in many other joints in your body, and occasionally, that disc or curtilage doesn't move optimally, or when you get older. Sometimes it just wears down period. Like arthritis, you can get arthritis in your jaw joint. Oftentimes, that will produce a clicking, cracking, popping sound.
Most of those sounds are not something that needs to be directly addressed, as long as you're chewing comfortably and functioning normally. Oftentimes, it's keeping an eye on it. If it really is messing with your quality of life, there are treatment options, and I'd advise you to see your general dentist and possibly get a referral to a specialist to get that looked at.
Dr. David
Yeah, I think that's good. Just to summarize that in a super concise way, I think the takeaway points from that is, the jaw joints are complicated. It's not just like a hinge joint. There's a bunch of funny movements and then just like you hear about in knees, there's a movable piece of cartilage in there, discs is what they call it, kind of similar in the spine and having compare that to, it's not an exact analogy, but it's very effective.
That disc can be injured, or it can shift in funny ways, or in that can produce clicking sounds. Even can hurt or make the jaw move unevenly. But it basically would fill up here is saying is if it doesn't hurt or isn't affecting, eating or doing anything with your mouth, then not a big thing to worry about, at this point, just monitor it makes sure it's not getting any worse.
Philip Buckler
In general. Yeah. And just kind of like you keep an eye on a knee that tends to pop when you move in a certain way. Same deal with your jaw. There's actually a very in-depth sub specialty of dentists, that and often general dentists will become certified through additional fellowships through this, that specializes in treating disorders of the jaw joint. If it's really messing with your quality of life, that's when you might want to consider seeing one. However, for most people. It's that degree of intervention isn't warranted. It's pretty extreme. But for those people who need it is it can often be very beneficial.
Dr. David
Yep. Super good information. I love this. One of the things that we were talking about, before we started recording here, was about diet and about what you're eating and how that might affect your dental health.
Philip Buckler
Yeah, so when I see someone with good hygiene, who also was developing a bunch of decay, and they don't have anything in their medical history, like radiation therapy, that would decrease their salivary flow, then it's the typical culprit is diet. The way cavities form in your teeth of course, like any other part of your body bacteria likes to live there. It's a nice warm, wet environment. So, bacteria like to live there even more than most places bacteria like to live.
That's why you need to clean it once every 24 hours in order to keep those bacterial colony sizes down. Whenever you put something with calories, or burnable calories in your mouth, the bacteria that are living on your teeth will metabolize that as their waste product, secrete acid, and that acid will not only decrease the pH of your saliva below the point where your minerals start leaching out of your teeth. But of course, they'll also do that in a much more localized focused area on the teeth, which is why you don't want to let any bacterial colonies grow in specific areas on your teeth for any extended period of time.
A lot of areas that people miss, tend to be done by the gum line, especially on the canines and second molars, because those are those areas that people miss. So, don't let plaque buildup back there. But when those areas, those bacteria in those colonies are fed, the pH of your mouth will drop below the mineralization threshold for about 20 minutes according to the classic studies. Every time you take a bite of something with calories, or sip something with sugar, or any other calories, not just sugar, but oatmeal is kind of a Greek culprit that a lot of people don't know about.
That will basically restart that 20-minute timer. So as far as your teeth are concerned, it's usually not how much you eat. It's, in terms of sugar, how often you eat it. If you're nursing an energy drink throughout the day, that's a lot worse for your teeth than say, downing three meals a day, even if they're pure sugar, the rest of your body, your pancreas would object to that much sugar. Your teeth you won't have nearly the problem. So again, it's kind of a moderation thing and unsweetened coffee, unsweetened tea will stay in your teeth. But if you're looking for some kind of an energy buzz or a caffeine buzz, I would suggest developing a taste for unsweetened teas, unsweetened coffees, because well, they'll stain your teeth, but they won't damage them. Caffeine in and of itself doesn't actually lower the pH. of your mouth.
So, it's kind of an indirect effect, but your body actually deals with that because your saliva is super saturated with minerals. When the pH in your mouth is at normal resting pH your teeth will actually absorb minerals, from your saliva, which is good in general. But at the same point in time, once they've absorbed enough minerals, you start to get mineral deposits on your teeth.
It's a very fascinating engineering trade off. You get the deposits on your teeth, but those calculus deposits will irritate your gum tissue. And, of course vector you'd like to live on the calculus deposits because they're much more varied in terms of surface area, and they're harder to clean. So that tends to lead to more gum disease.
The areas of your mouth that are most resistant to decay, also tend to be the most prone to Calculus buildups and bone loss and gum disease. Usually, that's where your salivary glands empty so there's no direct solution. It's only engineering tradeoffs, and it's very interesting, and you can hope that by keeping your teeth clean. Some people with more mineralized saliva just tends to build up more calculus. So, life isn't fair. Some people do need to visit the dentist four times a year, and some people can get away with visiting the dentist one time every seven years. And they're good.
Dr. David
Yea my wife is lucky. I have to go on a regular basis and I'm happy to. I always tell people I will use a Sonicare, I will get a high-end toothbrush, I'll floss, I'll use the water pick whatever it is. I want to go to my grave with good looking teeth.
Philip Buckler
Yeah, and one thing I hear oftentimes, I'm never quite sure how serious people are about this, that they'll just get their teeth taken out and get dentures, and that dentures are way better than nothing. Don't get me wrong, newer dentures that are Implant Supported. I'll be honest, that costs about the price of the new car to get an implant supported set of dentures, but man, they're functional jewelry that's worth it.
If I ever get into a major accident and lose my teeth, I'm going to remortgage my house to get implants supported dentures, because the difference is amazing. But even normal dentures, or even little dentures are still way better than nothing. But they are like prosthesis for your mouth.
You don't get the same kind of function with a denture that you would get with normal teeth, you don't get the same tactile feedback. And it's almost like wearing a custom-made pair of shoes in some ways. Your mouth also changes over the course of your life like the rest of your body. And one of the things that goes on in the case of dentures is that your bone sticks around to support your teeth. When you have no teeth there, the bone will gradually remodel and recede. So, the dentures gradually become loose and fallouts.
Oftentimes, dentures have to be remade, and by oftentimes, I mean once every three to five years and oftentimes more in order to keep them functioning well. And if they don't function well, if they develop sore spots, they're very uncomfortable to wear and they can be normal situations and so there is a learning curve to using them. You don't get the same tactile feedback. But again, they're a lot better than nothing. And if your dentist recommends dentures, it's probably because the health benefits of keeping your teeth in place are now outweighed by the benefits of taking those teeth out.
Because when teeth get loose enough to the point where you can't clean them, or the bacterial colonies get big enough, your mouth is very resilient, and it has an excellent blood flow and can bring far more white blood cells to the site than almost any other part of your body. But at the same point in time, that bacterial load does still play stress on your body. So eventually, if a tooth gets loose enough, the question isn't going to come out. But is it going to come out on your terms or its terms and are you going to have to get it out when you have a chronic infection that's losing puss…
I'm sorry, I don't mean to gross everyone out. but I've seen cases, so generally a controlled plant removal of teeth followed by the delivery of a prepared denture or followed by multiple impressions to make a denture for your mouth as it is, once it finishes its healing remodeling process is a much better alternative to letting things go on their own.
That being said, again, there's compromises and tradeoffs. Everyone has to decide for themselves, as an individual where they're at. And of course, there's costs for dental treatment, you just have to make the best judgment call you can about how you're functioning with the teeth that you have.
Now, if you if you ever have to look into that situation, or you're ever faced with that choice, see where your teeth are at now, versus where you would be with dentures, and just kind of make that call and decide when that would be right for you. That will vary from case to case. I see my role as a dentist to give people the information they need to make the informed decision that's right for them, rather than necessarily dictating to the decision to them.
Oftentimes people ask me what the best option is. In that case, I look at their teeth and I'm like, well, if your teeth are my teeth, here's what I did. But oftentimes there's plenty of good options. There's a joke that if you go to 10 different dentists you will get 10 different treatment plans.
That's not because dentists are blind, it's just because there are multiple ways to approach a problem. And a lot of these teeth problems are not just medical, but they're also mechanical. And there's multiple ways to get to the right solution. Dentists are individuals in terms of what works best in their hands, it's the same thing that you would run into in terms of a surgeon who recommends a particular procedure that they're very good at, which is where you get the Doctor of Dental Surgery degree or a different approach.
If you're in doubt and you're contemplating a course of dental treatment, whether it's expensive or invasive, or just because you want to educate yourself, one of the best investments that you can make is to get a second opinion. Once you find a good dentist, stick with them, and there's a lot of good dentists in El Paso. The El Paso district dental society actually does have a large number of good people that I know quite a few. And there's a lot of excellent dentists in El Paso. And that number is growing.
Dr. David
This is awesome Philip, this has been phenomenal information. I feel like we cover the whole gamut. We talked about kids a bit. We talked about, what you should be doing normally. And then we even went into end of life, dental hygiene, talking about the dentures and all that stuff.
Philip Buckler
Yeah, thank you for your time. I know I can get long winded on this, and there's so much more that could be said, and people are keeping their teeth longer. It's just great. What's going on dentistry as far as the advances that are being made even just every year.
Dr. David
Yeah. That's awesome. It's very exciting. Well, thank you so much for your time, Philip. I really appreciate it. Hey, everybody, for those of you listening right now, go on to the platform that you heard this podcast on, whether that's Apple platform, the Google platform, Android, wherever you're going listening to this.
If you want to get more health information just like Phillip said, so that you're in the best position to make the best decision about your health. Educate yourself and hit subscribe so that you get notified about when we put out more information so that you can learn more about how to stay healthy in El Paso. Thank you so much, and we'll talk soon. Bye. Thank you.
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